For the Boys: Why We’re Still Talking About Men’s Mental Health and How We Can Move the Ball Forward
I believe we’re in a conflicted era when it comes to men’s mental health. A quick google search turns up numerous anti-stigma campaigns (e.g., headsupguys.org, movember.com, manup.how, mantherapy.org, etc.) which are primarily aimed at encouraging men to have more open conversations about mental health and providing paths for care-seeking. At the same time, the host of America’s most popular podcast (I’m making the choice to omit the name; the platform is already popular enough) made the following statements last February over the course of the episode focused on critiquing the therapy industry, “…The people that I know that are in therapy, the ones that are in therapy regularly, are the most [expletive omitted] up, and I don’t see improvement…there’s something about going to a therapist and talking about yourself constantly and your problems constantly that sort of reinforces the self indulgent…Thinking and talking about your problems all of the time literally makes them grow.” It should be noted, over the course of the episode, the host and his guest make multiple passing comments about how specific types of evidence-based therapies (i.e., Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, etc.) offer tools that help therapy clients to advance beyond “talking about problems” to improve their mental health and life circumstances. Those nuanced pieces of the conversation are unfortunately absent from the countless short-form video clips of the interview that circulate popular social media sites; instead, statements like the quote above stand alone. The podcast currently has 19.6 million subscribers on YouTube and, last year, had 14.5 million followers on Spotify with a viewer/listener base that is 80% male-identifying and 51% between the ages of 18 to 34 years (Edison Research, 2024; Carman, 2024). The above is a lot of exposition to say, no matter the number of anti-stigma and “Let’s Talk About It”-style campaigns, the men in your life are likely still receiving anti-therapy messaging in the media they consume, exacerbating a longstanding problem: men are already less likely to engage in and complete mental health treatment than other gender groups (National Center for Health Statistics, 2022; Valenstein-Mah, 2019).
In his book, “Of Boys and Men: Why the Modern Man is Struggling, Why It Matters, and What to Do About It,” Richard Reeves (2022) confesses his hesitancy to write a book about boys and men, noting the complexities of discussing the difficulties faced by a privileged group in a world where understandings of gender and related oppression are increasingly complex and politicized. I can empathize with Reeves, as I write this post. There are so many groups who would benefit from increased access to therapy; talking about men’s issues is not meant to subtract from the needs of other groups. The problem I see, though, is that boys and men, even when they have access to care, are less likely to reap the benefits of good care. Lack of care is particularly concerning given the higher rates of substance use and death by suicide among men than those comparison groups (American Psychological Association, 2018), men’s general tendency to earn lower scores on emotional literacy in comparison to women (Brackett, Mayer, & Warner, 2004), and a host of unique “men’s issues” (i.e., navigating issues of identity and self-concept in relation to masculinity) that are associated with suffering. The takeaway here is that there are men who you know that are likely to benefit from therapy, but getting them to participate may be a major part of the battle.
Starting the Conversation
It feels a little inauthentic to focus on “starting the conversation.” The “Men’s Mental Health Crisis” is a term that has already been coined and written about repeatedly. Here, I’m focusing more on how you can begin a conversation with the men in your life whom you care for and may be concerned about but are yet to be open to engaging with mental health services. Research has shown that the vast majority of men in therapy have, to some degree, been influenced by another person to seek care, and over a third believe they may not have sought therapy at all without said influence (Cusak et al., 2004). Intimate partners, friends/relatives, and healthcare professionals were all shown to be significant influences. With increasing awareness around men’s mental health, men may be more likely to seek care on their own, but your ability to have a compassionate and candid conversation encouraging a man to seek help, may be a driver that helps them to make a change.
Interestingly, even among men who are aware of their own mental health concerns, perceived barriers have been shown to stop them from working with a therapist. Significant portions of men endorse concerns such as shame and embarrassment about talking to a therapist, not knowing what to look for in a therapist, doubting therapy’s effectiveness, and believing that they need to solve their own problems as factors that get in the way of their willingness to meet with a therapist (Seidler et al., 2020). The same study showed that 50% of the men surveyed reported that they did not personally know anyone who had benefit from therapy, which was also cited as a reason to avoid mental health services. This means that if one is going to start the conversation encouraging men to start therapy, additional information about how to navigate common barriers could help to clear the path. Presumably, if you’re reading the blog of a therapy practice, you have first-hand experience with the benefits of therapy and navigating some of these barriers; your willingness to share that experience could be invaluable.
Building and Maintaining Momentum
“So a man walks into a therapist's office…” sounds like the setup for a bad joke, but that’s about where a lot of men’s mental health advocacy leaves off. Getting men through the door of a therapist's office is a start. That being the primary focus, though, can leave them a bit uncertain as to what they want from therapy. As a therapist who regularly works with men, I commonly hear treatment goals like, “I guess I’m just looking for someone to talk to.” Let me be clear; there is nothing wrong with seeking out a safe space to process stress. A therapist’s office can be a great place to do just that, and doing so is likely to be a part of even the most focused skill-based therapies. Therapy can offer a lot more than processing though, and clear treatment goals have been shown to reduce dropout (Gates et al., 2021), an important consideration given men typically attend fewer therapy sessions and are more likely to prematurely drop from therapy compared to women (Valenstein-Mah et al., 2019; Seidler et al., 2020). A good therapist is likely to work with the client in educating and guiding the client in the creation of treatment goals, but men who are entirely unsure of their goals during their first session may require additional time discussing their treatment needs in comparison to those that begin treatment with pre-identified goals. This is particularly concerning, given that around one quarter of men who drop out of therapy do so after a single session (Siedler et al., 2020). Literature reviews have shown that men respond best to action-oriented, goal-focused treatment styles (Siedler et al., 2018), meaning, if we are going to encourage men to seek treatment, spending some additional time working with them to identify specific goals may help to speed up the process of working toward those goals, keeping them engaged in treatment.
Similarly, certain therapy/therapist factors have been associated with improved outcomes in men. Therapists who are willing to use appropriate self-disclosure, employ a collaborative and transparent approach, and are willing to use male-oriented language and metaphors have been shown to improve outcomes in working with men (Siedler et al., 2018). Once therapy has begun, the process of assessing whether a specific therapist or therapeutic style is aligned with the client’s goals can feel daunting, or even discouraging if there is an improper fit. Encouraging men who may be hesitant to continue in therapy to continue this assessment, however, may help them to make decisions about finding the right fit, increasing their willingness to continue therapy until their goals are met.
Reaping the Rewards
In 2018, the American Psychological Association released their first ever “Guidelines for Psychological Practice with Boys and Men,” with the intention of increasing psychology’s effectiveness in working with boys and men. Critics, however, made claims that the guidelines, at times highlighting the socialized aspects of gender and difficulties raised by select aspects of masculinity, were disparaging and pathologizing to traditional masculinity (Ferguson, 2023). I believe that this type of debate is a component of what keeps a portion of men at odds with therapy. If either side buys into the debate that therapy is anti-masculinity, those who appreciate aspects of their masculinity become inherently “anti-therapy,” regardless of any suffering they may be experiencing. Vocal proponents of traditional masculinity have gotten wind of this dynamic and have begun to use it to their benefit. The recent Netflix series, “Adolescence” makes a nod to hyper-masculine digital misinformation networks (i.e., “the manosphere”) leveraging the loneliness and difficulties faced by boys and men to increase online engagement. A deep dive on the topic would constitute far more than a blog post, but the fictional series is intended to provide a commentary on a very real problem of men’s issues giving rise to broader societal issues. That’s not to say that every man who struggles is destined to be pulled to dark corners of the internet if they do not go to therapy first; it’s just to say that there are men who are searching for ways to cope with their difficulties who may have ruled out therapy from their search.
In contrast, I see advancing the mental health sector’s ability to engage and work with men, across varying degrees of attachment to traditional masculinity, as a way to push back on these difficulties. Therapy vs. masculinity is a false dichotomy, but it is likely up to those who have seen the benefits of therapy firsthand to disrupt this narrative. By bringing men into the therapy space, showing them how therapy can help them reach goals that are meaningful to them, and doing so in a way that feels approachable to their current worldview, we open the door to the possibility of new versions of masculinity and men’s mental health. To quote the psychiatrist, Irvin Yalom, “The spirit of a man is constructed out of his choices.” I believe that the choice to seek improvement is the choice to become a better man.
Thinking of a man in your life that could benefit? Get connected with Ryan Page below…
References
American Psychological Association, Boys and Men Guidelines Group. (2018). APA guidelines for psychological practice with boys and men. Retrieved from http://www.apa.org/about/policy/psychological-practice-boys-men-guidelines.pdf
Brackett, M. A., Mayer, J. D., & Warner, R. M. (2004). Emotional intelligence and its relation to everyday behaviour. Personality and Individual differences, 36(6), 1387-1402.
Carman, A. (2024, March 21). Spotify reveals podcast numbers for Joe Rogan, Alex Cooper, Travis Kelce. Bloomberg. https://www.bloomberg.com/news/newsletters/2024-03-21/spotify-reveals-podcast-numbers-for-joe-rogan-alex-cooper-travis-kelce
Cusack, Jason, Frank P. Deane, Coralie J. Wilson, and Joseph Ciarrochi. "Who influence men to go to therapy? Reports from men attending psychological services." International Journal for the Advancement of Counselling 26 (2004): 271-283.
Edison Research. (2024, October 30). Who Joe Rogan listeners are likely to support in the election. https://www.edisonresearch.com/who-joe-rogan-listeners-are-likely-to-support-in-the-election/
Ferguson, C. J. (2023). The American psychological Association's practice guidelines for men and boys: Are they hurting rather than helping male mental wellness?. New Ideas in Psychology, 68, 100984.
National Center for Health Statistics. (2022). Mental Health Treatment Among Adults Aged 18–44: United States, 2019–2021. National Center for Health Statistics (US).
Reeves, R. V. (2022). Of boys and men: why the modern male is struggling, why it matters, and what to do about it. Brookings Institution Press.
Seidler, Z. E., Rice, S. M., Kealy, D., Oliffe, J. L., & Ogrodniczuk, J. S. (2020). What gets in the way? Men’s perspectives of barriers to mental health services. International Journal of Social Psychiatry, 66(2), 105-110.
Seidler, Z. E., Rice, S. M., Ogrodniczuk, J. S., Oliffe, J. L., & Dhillon, H. M. (2018). Engaging men in psychological treatment: A scoping review. American journal of men's health, 12(6), 1882-1900.
Valenstein-Mah, H., Kehle-Forbes, S., Nelson, D., Danan, E. R., Vogt, D., & Spoont, M. (2019). Gender differences in rates and predictors of individual psychotherapy initiation and completion among Veterans Health Administration users recently diagnosed with PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 11(8), 811.